What are my chances of looking good after en bloc removal?

Question

I am a 57 yr old woman that only weighs 95 lbs.  When I got my gel implants I weighed 117 and it has been 13 yrs since getting them.  I don't want them anymore.  I want an en bloc removal with no implants put back in.  What are my chances of my breast size going from A/B w/o implants to 325cc with implants (a C cup) being back to normal after removal of implant and capsule?  It's really important to me to get these out of my body but I don't want to look freakish to my husband either.  I'm so stressed about this.  The PS I went to completely ignored the fact that I want them out, said he could do it but leaned hard on getting smaller ones.  I think they are making me sick.  I need them out of my body.  Please help if you can.  Will it take a full year before they look close to normal after removal.  The photo's I see right after procedure scare the hell out of me.

J. Jason Wendel, MD, FACS · Answer

Thank you for your question. Pictures would be helpful.It is likely that your breast will be small after implant removal, but you are petite too at 95 lbs.  This would seem proportional to your body.  As long as you are okay with that, no problem.It's not about what your plastic surgeon wants, and it's not about what your husband may like or prefer.  It's about what you want. It's your body and ultimately your decision.Yes, it may take a full year for all of the healing and for your final appearance.  A breast lift may or may not be necessary or desired.  Small and perky is not a bad thing.To be sure, return to discuss these details with your plastic surgeon or see two or more board certified plastic surgeons for a consultation to make sure you are a good candidate and that it is safe for you to have surgery.I hope this helps.

Lewis Albert Andres, MD · Answer

Hello! Thank you for your question! It is a matter of surgeon preference as well as what is seen during your procedure that will determine whether or not a complete capsulectomy is performed. I have always favored a complete capsulectomy vía en bloc method.  Although a more complex and skilled procedure, I believe it to be the best method, especially given concerns today  A true en bloc will keep the implant and all contents within as one piece throughout the removal without violating the capsule and opening it up during the procedure.  
If significant capsule formation is seen intraoperatively, a full capsule removal may be warranted with a drain in order to completely remove all of the tissue and allow better adherence of your breast back to its normal anatomic position down on your chest wall. If minimal contracture is seen, it may be possible to leave the capsule, or place cuts within the capsule to allow better adherence.  It is still not completely understood what forms the capsule, but the popular theory would lead most to removing it entirely. It truly is dependent on what is seen with your capsule and the issues that may be causing you to have such a procedure (e.g., contracture from rutptured implant vs pain vs simple pocket adjustment, etc).  But, I completely believe in removal of the entire capsule, en bloc, for several reasons - removal of entire capsule that wasn’t there to begin with, adherence of tissue back to where it started, improved breast contour for revision, and not exposing the body to any implant material or periprosthetic fluids/contents that are within the capsule and in vivo.  These are just a few important that en bloc addresses. Drains should be used to remove the fluid that will inevitably develop in the potential space.   Without knowing your issues and without an examination, it is difficult to tell you what may be the best thing for you. I favor performing capsulectomies (in an en bloc fashion) in order to create a fresh pocket, reshape the pocket, allow better shape and adherence of the overlying breast, and suturing the muscle back to where it started from. I would discuss your issues with your plastic surgeon who will assist you in determining the right modality for you. Given the capsule formed from the foreign object and was not there to begin with, as well as some theories of what exactly is a capsule and what causes it to form...I favor complete capsule removal.  I would expect a somewhat similar appearance as if you have not had implants, as your breasts have also aged over the past few years. The decision on whether a lift may be performed depends on how much of a lift is needed and ultimately vascularity to the breast.  Otherwise, consideration as a staged procedure with/out fat grafting may be done then or at same time.  Most are back to regular things within a week. Activity restrictions for ~6 weeks along with a compression bra.  Hope that this helps!  Best wishes!

John Michael Thomassen, MD · Answer

Implant removal without replacement or lift can leave a breast shape that is hypoplastic and not have adequate shape.  The implant over time puts pressure on the parenchyma that may atrophy it so it appears you have volume deficiency in the upper pole of the breast.  Are saline implants an option or is mastopexy an option?  They may look fine depending on the amount of parenchyma you have.  Photos would help.  Best wishes!

Connie Hiers, MD, FACS · Answer

If you want your implants removed, than do so.  Of course, your breasts will not look exactly like they did before implantation. You can discuss what your options are--removal, smaller implants, or possible fat injections.  Many studies have shown that breast implants do not cause illness, but worry can. If you are unhappy with your breasts after implant removal, you still can have smaller implants placed.  I would suggest discussing all your concerns with your surgeon.

What are my chances of looking good after en bloc removal?

Answers (4)

Answer: Implant removal

Answer: Implant removal

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What are my chances of looking good after en bloc removal?

Answers (4)

Answer: Implant removal

Answer: Implant removal

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Everything you need to know about En Bloc Capsulectomy

Our mission is to create a world where every investment in modern beauty is Worth It.